504 EXAM 4: FITZGERALD GU PRACTICE
QUESTIONS AND ANSWERS
When prescribing antihypertensive therapy for a man with BPH and hypertension,
the nurse practitioner (NP) considers that:
A. loop diuretics are the treatment of choice.
B. an alpha1-antagonist should not be used as a solo or first-line therapeutic agent.
C. angiotensin receptor antagonist use is contraindicated.
D. beta-adrenergic antagonist use often enhances urinary flow. - ANSWER B. an
alpha1-antagonist should not be used as a solo or first-line therapeutic agent.
The use of alpha blockers as a solo or first-line antihypertensive agent has been
associated with higher-than-expected rates of stroke and heart failure. Alpha
blockers should be considered as a desirable agent in treating a man with
hypertension and BPH but only as medication added on to existing
antihypertension therapy; an alpha blocker that is specifically indicated for BPH
therapy only, such as tamsulosin, has minimal effect on blood pressure.
Which of the following medications can contribute to the development of acute
urinary retention in an older man with BPH?
A. amitriptyline
B. loratadine
C. enalapril
D. lorazepam - ANSWER A. amitriptyline
Drugs with anticholinergic effect, such as tricyclic antidepressants (amitriptyline,
nortriptyline, and imipramine) and first-generation antihistamines (e.g.,
diphenhydramine [Benadryl®], chlorpheniramine [Chlor-Trimeton®]), can cause
acute urinary retention in men with BPH; opioid use and inactivity also increase
the risk of urinary retention.
Finasteride (Proscar®, Propecia®) and dutasteride (Avodart®) are helpful in the
treatment of BPH because of their effect on:
A. bladder contractility
B. prostate size
, C. activity at selects bladder receptor sites
D. bladder pressure - ANSWER B. prostate size
The use of finasteride (Proscar®) and dutasteride (Avodart®), 5-alphareductase
inhibitors that block the conversion of testosterone to dihydrotestosterone, helps to
reduce the size of the prostate and ameliorate symptoms.
Tamsulosin (Flomax®) is helpful in the treatment of BPH because of its effect on:
A. bladder contractility
B. prostate size
C. activity at selects bladder receptor sites
D. bladder pressure - ANSWER C. activity at selects bladder receptor sites
The prostate and bladder base contain numerous alpha1 receptor sites. When these
receptor sites are stimulated, the prostate contracts, increasing outflow tract
obstruction. As a result, treatment with alpha1 receptor antagonists (alpha
blockers) including tamsulosin (Flomax®) can be helpful in improving the
symptoms of BPH.
Concerning herbal and nutritional therapies for BPH treatment, which of the
following statements is false?
A. The mechanism of action of the most effective and best studied products is
similar to prescription medications for this condition.
B. These therapies are currently considered emerging therapies by the American
Urological Association.
C. Major areas of concern with use of these therapies include issues of product
purity and quality control.
D. These therapies are safest and most effective when used with prescription
medications. - ANSWER D. These therapies are safest and most effective when
used with prescription medications.
Herbal and nutritional therapies, including saw palmetto, rye, and pumpkin, are
considered emerging therapies by the American Urological Association, pending
further study. The observed effect of these plant-based therapies is usually
attributed to a mechanism of action similar to approved prescription BPH
therapies. As with other herbal and nutritional therapies available over-the-counter
(OTC), issues of product purity and strength and potential interaction with
prescription and other OTC products remain a concern.
QUESTIONS AND ANSWERS
When prescribing antihypertensive therapy for a man with BPH and hypertension,
the nurse practitioner (NP) considers that:
A. loop diuretics are the treatment of choice.
B. an alpha1-antagonist should not be used as a solo or first-line therapeutic agent.
C. angiotensin receptor antagonist use is contraindicated.
D. beta-adrenergic antagonist use often enhances urinary flow. - ANSWER B. an
alpha1-antagonist should not be used as a solo or first-line therapeutic agent.
The use of alpha blockers as a solo or first-line antihypertensive agent has been
associated with higher-than-expected rates of stroke and heart failure. Alpha
blockers should be considered as a desirable agent in treating a man with
hypertension and BPH but only as medication added on to existing
antihypertension therapy; an alpha blocker that is specifically indicated for BPH
therapy only, such as tamsulosin, has minimal effect on blood pressure.
Which of the following medications can contribute to the development of acute
urinary retention in an older man with BPH?
A. amitriptyline
B. loratadine
C. enalapril
D. lorazepam - ANSWER A. amitriptyline
Drugs with anticholinergic effect, such as tricyclic antidepressants (amitriptyline,
nortriptyline, and imipramine) and first-generation antihistamines (e.g.,
diphenhydramine [Benadryl®], chlorpheniramine [Chlor-Trimeton®]), can cause
acute urinary retention in men with BPH; opioid use and inactivity also increase
the risk of urinary retention.
Finasteride (Proscar®, Propecia®) and dutasteride (Avodart®) are helpful in the
treatment of BPH because of their effect on:
A. bladder contractility
B. prostate size
, C. activity at selects bladder receptor sites
D. bladder pressure - ANSWER B. prostate size
The use of finasteride (Proscar®) and dutasteride (Avodart®), 5-alphareductase
inhibitors that block the conversion of testosterone to dihydrotestosterone, helps to
reduce the size of the prostate and ameliorate symptoms.
Tamsulosin (Flomax®) is helpful in the treatment of BPH because of its effect on:
A. bladder contractility
B. prostate size
C. activity at selects bladder receptor sites
D. bladder pressure - ANSWER C. activity at selects bladder receptor sites
The prostate and bladder base contain numerous alpha1 receptor sites. When these
receptor sites are stimulated, the prostate contracts, increasing outflow tract
obstruction. As a result, treatment with alpha1 receptor antagonists (alpha
blockers) including tamsulosin (Flomax®) can be helpful in improving the
symptoms of BPH.
Concerning herbal and nutritional therapies for BPH treatment, which of the
following statements is false?
A. The mechanism of action of the most effective and best studied products is
similar to prescription medications for this condition.
B. These therapies are currently considered emerging therapies by the American
Urological Association.
C. Major areas of concern with use of these therapies include issues of product
purity and quality control.
D. These therapies are safest and most effective when used with prescription
medications. - ANSWER D. These therapies are safest and most effective when
used with prescription medications.
Herbal and nutritional therapies, including saw palmetto, rye, and pumpkin, are
considered emerging therapies by the American Urological Association, pending
further study. The observed effect of these plant-based therapies is usually
attributed to a mechanism of action similar to approved prescription BPH
therapies. As with other herbal and nutritional therapies available over-the-counter
(OTC), issues of product purity and strength and potential interaction with
prescription and other OTC products remain a concern.
